Starting in plan year 2027, commercial health insurers in the individual and group markets would be required to publicly post the share of every premium dollar spent on patient claims, quality improvement, and overhead or profit under legislation sponsored on June 23 by U.S. Rep. August Pfluger (R-TX).
The Premium Transparency Act, H.R. 9397, would set such requirements for health insurers and Medicare Advantage plans, and would direct the U.S. Department of Health and Human Services (HHS) to standardize how insurers communicate benefits and cost-sharing, giving consumers the ability to make true comparisons between plans.
“Americans deserve to know where their health insurance dollars are actually going. Right now, insurers are required to spend at least 80 to 85 cents of every premium dollar on patient care, but that data is buried in regulatory filings that few Americans ever see,” Rep. Pfluger said. “This legislation changes that, bringing prices into the open in plain language that any patient, family, or employer can understand.”
At the same time, H.R. 9397 would apply the same disclosure standard to Medicare Advantage organizations, requiring plan-level public reporting of total revenue, claims spending, non-claims costs, and the resulting medical loss ratio, according to a bill summary provided by Rep. Pfluger’s office.
This provision comes at a time when Medicare Advantage gross margins per enrollee have reached $1,655, the highest of any insurance market, the summary says.
Additionally, HHS would be directed to issue guidance by Jan. 1, 2028 on standardizing how plans communicate premiums, deductibles, and cost-sharing for common services in plain English. The healthcare exchanges also would have to display this data alongside plan offerings, states the summary.
Both the U.S. House Energy and Commerce Committee and the U.S. House Ways and Means Committee are considering the bill.